Depressive Disorders

Depressive Disorders

Depressive DisordersIncludes:1. Disruptive mood dysregulation disorder2. Major depressive disorder3. Persistent depressive disorder4. Premenstrual dysphoric disorder5. Substance-induced depressive disorder6. Depressive disorder due to another medical condition7. Other specified depressive disorder

How Do People Feel?SadEmptyIrritableCognitive changesSomatic changesAll of these significantly affect the individuals ability to function

1. Disruptive Mood Dysregulation DisorderFor children up to 12 years oldChildren were being over-diagnosed with bipolar disorderOccurs in approx. 2-5% of the child populationHigher in males and school-age children than females and adolescents

DMDD symptomsSevere irritabilityHave lots of outburstsDisruption of family and friend relationshipsAffects school performanceLow frustration toleranceDangerous behaviorsSuicidal ideationSevere aggression

DMDD Diagnostic CriteriaDiagnostic Criteria Include:Severe recurrent temper outbursts manifested verbally (ex. rages), and/or behaviorally (ex. physical aggression) that are out-of-proportion to the situation or provocationThe outbursts must be inconsistent with the developmental level

DMDD Diagnostic Criteria contdThe outbursts must occur 3 or more times per weekThe mood between the outbursts must be irritable and mostly angryEveryone needs to observe it (teachers, parents, friends, etc.)Must be observed across a variety of settingsMust have been going on for a minimum of 12 monthsMust be diagnosed between 6 and 10 years oldThe behaviors can not be explained by substances, medication, other mental illnesses, or other medical or neurological conditionsDifferential DiagnosisYou must be careful when diagnosing Disruptive Mood Dysregulation Disorder because it has similar symptoms to:Oppositional Defiance Disorder (ODD)Bipolar DisorderADHDAutism Spectrum Disorder2. Major Depressive DisorderAt least 2 weeks durationCarefully have to look at normal sadness and grief and bereavement before diagnosingMDD is usually EPISODIC and SEVEREFigure the rest out on your own!Major Depressive Disorder contdRead the case about major depression and answer the following: What are the symptoms?What are the diagnostic criteria for MDD?What are the risk factors?What are the categories or specifiers in MDD?What can it often be confused with?What other disorders, if any, is it comorbid with?What are some treatment options for those diagnosed?What is the prevalence? Who does it affect most?3.Persistent Depressive DisorderAlso known as DYSTHYMIACan be diagnosed when the mood disturbance continues for at least 2 years in adults or 1 year in childrenNot episodic, but CHRONICLess severe than Major Depressive DisorderAffects 0.5% of the population

PDD Risk and PrognosisMore likely to get PDD when You are youngerHave higher neuroticismHave a poor GAF score (axis 5)Have anxiety disordersHave parental loss or separation as a childHave it in your family

PDD Diagnostic CriteriaDiagnostic Criteria Include:Depressed mood for most of the day for a period of at least 2 yearsPresence, while depressed, of at least 2 or more of the following: Poor appetite or overeatingInsomnia or hypersomniaLow energy or fatigueLow self-esteemPoor concentration or making decisionsFeelings of hoplessness

PDD Diagnostic Criteria contdThe criteria for Major Depressive Disorder may be present for the 2 yearsThere has never been a manic episodeThe disturbance is not related to any schizophrenic or psychotic disorderThe disturbance is not due to substance or medication use, or another medical conditionThe symptoms causes significant distress or impairment in social, occupational, and other important areas of functioning. Differential DiagnosisYou must be careful when diagnosing Persistent Depressive Disorder because it has similar symptoms to:Major depressive disorderPsychotic disordersDepressive disorders related to other medical conditionsSubstance-induced depressionPersonality disorders

4. Premenstrual Dysphoric DisorderUsed to be in the DSM-IV for further studyIt is now recognized as a formal diagnosis (after 20 years of research!)Occurs in 1.8%-5.8% of menstruating womenSymptoms worsen as they approach menopauseOral contraceptives help reduce symptoms

5. Substance/Medication-Induced Depressive DisorderThe symptoms followed with the onset of the substance (drug) or medicationThe symptoms persist for at least 1 month even after use has stoppedThe disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioningCan not be explained better by another depressive disorderCan be divided into mild, moderate, or severePrevalence is 0.26% in the USAWhat do you think the risk factors are?

6. Depressive Disorder Due To Another Medical Condition

Brain damage can definitely lead to depression!Be careful not to confuse it with a medication-induced depression or with an adjustment disorder (imagine having to adjust to having a medical condition )Most common in those who experience:StrokesHuntingtonss diseaseParkinsons disease